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Learning Disabilities Transition Pathway Competency Framework Health Education England www.hee.nhs.uk Developing people for health and healthcare www.hee.nhs.uk

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Page 1: Learning Disabilities Transition Pathway …...Learning Disabilities Transition Pathway 3 Health Education England gratefully acknowledges the contributions of a wide-range of people

Learning Disabilities Transition Pathway Competency Framework

Health Education England

www.hee.nhs.uk

Developing people for health and healthcarewww.hee.nhs.uk

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Acknowledgments ..............................................................................................................................................................................................................................x

Document purpose .............................................................................................................................................................................................................................x

Background ..............................................................................................................................................................................................................................................x

The transition workforce ................................................................................................................................................................................................................x

Transition - essential attributes and behaviours ...........................................................................................................................................................x

The Learning Disabilities Transition Pathway, key elements ...............................................................................................................................x

The Learning Disability Transition Pathway Competency Framework ..........................................................................................................x

Overview of Transition Pathway Competency Framework and Generic Service Interventions ..................................................x

1. Team competencies at transition .........................................................................................................................................................................................x

2. Leadership competencies at transition ...........................................................................................................................................................................x

3. Access to services, care coordination and risk management at transition ............................................................................................x

4. Assessment and formulation .................................................................................................................................................................................................x

5. Enabling interventions ...............................................................................................................................................................................................................x

6. Role support interventions ......................................................................................................................................................................................................x

7. Family and carer interventions .............................................................................................................................................................................................x

8. Accommodation and welfare interventions ...............................................................................................................................................................x

9. Monitoring and measurement, research and evaluation...................................................................................................................................x

Appendix 1 - Generic Service Interventions Pathway .............................................................................................................................................. x

Appendix 2 - The workshop .........................................................................................................................................................................................................x

Appendix 3 - Young people’s consultation ........................................................................................................................................................................x

Appendix 4 - Learning Disabilities Core Skills Education and Training Framework .............................................................................x

Appendix 5 - Career Framework ...............................................................................................................................................................................................x

Contents

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Health Education England gratefully acknowledges the contributions of a wide-range of people who have been involved in the development of this tool.

• Students and staff at Regent College, Stoke on Trent

• All attendees of the transition workshop in Birmingham

• All members of the Transition Reference Group

• Newpossibilities.co.uk

• Achieving Successful Transitions for young people with disabilities, A Practical Guide, Jill Hughes and Natalie Lackenbury, ISBN 978-1-84905-568-0, Jessica Kingsley Publishers

• Carolyn Knight ((Programme Manager) Black Country Partnership NHS Foundation Trust

• Skills for Health

Acknowledgments

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This document was commissioned by Health Education England to support the development of people working in services with young people with learning disabilities as they lead up to and make the transition from children’s to adults’ service provision.

Using the frameworkThe framework has particular relevance for:

• managers of services working with young people with learning disabilities at transition, who can use the framework to:

• better understand the development needs of the workforce

• help maximise the contribution of the existing workforce

• identify new ways of working within a framework that is person-centred and focused on improving health and care outcomes

• help identify the need for, and development of, new roles

• develop the multi-agency team.

• education commissioners – who can use the framework to support competency based learning and development programmes

• people with a learning disability and their carers who wish to contribute to the development of care services

• service commissioners and workforce development leads, who can use the framework to:

• gain an insight into the competency based workforce development approach

• help describe service models

• develop specifications and assurance activities that underpin the delivery of effective services.

Document purpose BackgroundThis Learning Disability Transition Pathway Competency Framework has been developed by Health Education England, working across the West Midlands in partnership with Skills for Health. It will support the development of successful transition teams, new roles and the identification of the components of effective education and training for those working with young people in transition.

Following development of a competency framework for learning disability services based on the Generic Service Interventions Pathway (Appendix 1), it was acknowledged that a more detailed approach to the period of transition between children’s and adults’ services was required.

While all points on the Generic Service Interventions Pathway remain relevant to the individual during transition, some areas have been identified as of particular significance and are included in this new Transition Pathway Competency Framework, with additional detail.

The resulting Framework focuses on the development of people working with young people with learning disabilities who are in transition from children’s to adults’ services. It should be viewed as complementary to a range of other competency frameworks, including:

• The Learning Disabilities Core Skills Education and Training Framework, which was commissioned and funded by the Department of Health and developed in collaboration by Skills for Health, Skills for Care and Health Education England. It describes core skills and knowledge i.e. that which is common and transferable across different types of service provision (Appendix 4)

• work done with Skills for Health to identify the additional characteristics of community and crisis teams following the publication of the Generic Service Interventions Pathway Competency Framework.

The transition period, from children’s to adult’s services, usually 14-25 years, can involve a wide range of professionals working across a number of different agencies. Ensuring a seamless transition from children’s to adults’ services has been a difficult

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challenge for services for many years. This Learning Disability Transition Pathway Competency Framework articulates the competencies required in order to help meet the development needs of the workforce. It has been informed by a range of professions from across the West Midlands whose role involves working with young people in transition, and whose representatives attended a transition workshop in May 2016, (see Appendix 2). The Framework includes behaviours and attributes that are necessary characteristics of a worker in order to enable a young person to make a successful transition. The Framework has also been informed by the views of young people with learning disabilities (See Appendix 3).

The competencies are mapped to National Occupational Standards, which describe the skills, knowledge and understanding needed to undertake a particular task or job to a nationally recognised level of competence and they focus on what the person needs to be able to do, as well as what they must know and understand, to work effectively. To help describe the level activities should be carried out by a post-holder, and to provide information relating to the values and behaviours inherent in an activity, the Skills for Health Career framework levels are summarised in Appendix 5, along with the relevant employability skills.

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The transition workforceThe transition workforce/team includes a range of workers. The diagram below outlines a selection of these.

• Clinical Psychologist

• Educational Psychologist

• Hospice Staff

• CAMHS/Adult Mental Health

• Continuing Healthcare

• Paediatrician

• Consultant

• School Health Adviser

• Health Care Assistant

• Nurse/School Nurse

• Occupational Therapist

• Physio

• Speech & Language

• Therapist

• Transition Nurse

• GP

• Psychiatrist

• Commissioners

• Behaviour Support

• Benefits Agency Worker

• Connexions/Careers Advisers

• Post 16 Tutor

• Further Education Staff

• Teaching assistant

• Training Provider

• Autism Outreach

• Hearing Impairment Service

• Visual Impairment Service

• Autism Outreach

• Physical Disability Support Service

• Headteacher

• SENCO

• Teacher

• SEN Assessors

• Parent Partnership Service

• Job Centre Adviser

• Commissioners

• Family/Carers

• Voluntary Agencies

• Support Groups

• Youth Workers

• Youth Offending

• Police

• Personal Assistant

• Housing Organisations

• Childrens Social Worker

• Adult Social Worker

• Social Care Support Workers

• Leaving Care Social Workers / PAs

• Respite/ Short Breaks Staff

• Personal Centred Planners

• Community Connect/Life skill workers

• Safeguarding workers

• Commissioners

• Residential Care Staff

• Advocate

Social CareHealth

Education/Employment

Community/ Home

The transition workforce

The transition workforce

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The team involved in the transition of a young person from children’s to adults’ services will not be a formal single service team, but will be multi-agency, multi-disciplinary, and include a number of professions. It will encompass a wide range of services, legislative requirements and conditions. Most importantly, it will include the young person and their family and carers.

Team working was explored in two earlier workshops in 2015. The key team attributes and skills identified in the workshops (listed below), resonate with the essential attributes and behaviours identified by delegates at the transition workshop in May 2016.

Key attributes of a successful team • Adequately resourced

• Clear remit and agreed goals

• Value based and person centred

• Proactive as well as reactive

• Excellent inter-agency links

• Supportive of each other

• Effective skill mix across professions and career framework levels

• Respectful of each other

• Prepared to challenge each other on a basis of trust

• Flexible

• Committed and accountable

• Developing and maintaining a learning environment

• Linked to main stream services

• Empathic

• Reliable and consistent

Transition - essential attributes and behaviours At the transition workshop delegates identified a number of essential attributes, behaviours and related skills required to ensure the safety and wellbeing of a young person moving from children’s to adults’ service provision. Some of these characteristics are innate to the individual worker, but most can be enhanced and developed by experience and reflection, exemplified and encouraged by others working in the service.

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The Learning Disabilities Transition Pathway - key elements It was clear from the transition workshop that there was no standard pathway for transition across the West Midlands, with:

• varied approaches to transition within different services and in different geographical areas

• different ages at which different services start to engage with the young person

• changes in eligibility as the young person moves through the system.

Workers should be Workers should have

• Respectful

• Honest

• Trustworthy

• Open and transparent

• Non-judgmental

• Patient

• Resilient

• Caring

• Compassionate

• Understanding

• Empathetic professional

• Approachable

• Consistent

• Able to negotiate

• Able to mediate

• Able to work in partnership

• Courageous

• Aspirational

• Integrity

• Emotional intelligence

• Professional curiosity

• Shared values

• Share a vision commitment

• Time to talk and to listen, listening skills

• Common sense

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Key elements for a successful transition were identified as crucial throughout the pathway. These elements influence and inform every section of the Competency framework. These are illustrated below:

The key elements can be found throughout the framework and are crucial for the effectiveness of each of the competency areas. For example, communication skills are fundamental and required in every competency in the framework, be it communication with young people, their families, other team members, or those working in other services.

• Transition Planning starts early

• Early information sharing

• Earlier involvement of professionals including Adult services

• One Transition Pathway across edu-cation, health and social care

• Joint working with shared values

• Understanding roles and responsibilities

• Transition Workers with navigation and coordination skills

• Joint commissioning

• Single point of access

• Joint training across professionals on Transition

• Effective Communication

• With young people

• With carers

• Between professionals

• Utilise a range of communication methods dependent on needs

• Accessible information

• Active listening

• Person centred planning

• Promoting independence

• Empowering young people

• Community Integration

Early Planning

Communication

Multi agency co-ordinated working

Preparation for Adulthood

Person Centred

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The Learning Disability Transition Pathway Competency FrameworkThis new Learning Disability Transition Pathway Competency Framework is based on the Learning Disability Generic Service Interventions Pathway Competency Framework. The table below outlines what each of the competencies mean to people with learning disabilities and demonstrates the relationship between the Learning Disability Generic Services Competency Framework and the Learning Disability Transition Pathway Competency Framework.

Competencies Learning Disability Generic Service Interventions Pathway Competency Framework

Learning Disability Transition Pathway Competency Framework

What It means for people with learning disabilities

Team competencies √

Leadership competencies √

Promoting appropriate access to services

Supporting individuals √ √ “I know how to get the right service for me”

“My care is managed well and I am involved in all decisions”

“I have the right information and enough time to make decisions”

“I feel safe and I am allowed to make mistakes just like everyone else”“I don’t hurt myself or other people”

“When things go wrong I know what to do to start to make things better”

Planning and implementing services √ √

Managing referrals, transfers, transitions and discharges

√ √

Managing a care programme approach including care planning

√ √

Positive risk management (including risk to self and others, safeguarding and personal safety)

√ √

Crisis and emergency planning √

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Competencies Learning Disability Generic Service Interventions Pathway Competency Framework

Learning Disability Transition Pathway Competency Framework

What It means for people with learning disabilities

Assessment, formulation and treatment planning

Undertaking assessment processes including functional analysis

√ √ “People who help me understand what I am able to do and support me to make decisions for myself”

’When I cannot make a decision for myself, people know what I would like to happen”

“People who help me all understand what they can do together to start to make things better”

Mental capacity √ √

Processing information and formulation

Treatment planning √

Enabling health interventions

Signposting and supporting access to mainstream health services

√ “I am listened to”

“People who help me know who else can help me too”

“I know what to do to stay healthy”

“People make sure that I am treated the same as everyone else (even if they have to change things to make this happen)”

“I get help to plan my future

Promoting healthy lifestyle choices √

Supporting choices and self-determination

√ √

Promoting effective communication about health needs

√ √

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Competencies Learning Disability Generic Service Interventions Pathway Competency Framework

Learning Disability Transition Pathway Competency Framework

What It means for people with learning disabilities

Role support interventions

Supporting person centred activities and functioning: independence (including personal budgets), communication, social, spiritual, sexual health and personal care also mitigate other stigmatising factors

√ √ “I am listened to”

“The people who know me know what I like and help me to do the things I want to do”

“I get help in the same way as everyone else (even when things need to change to make this happen)”

“I have a busy and fun life”

“I get help to plan my future”

“I know what I am doing in the future”

“I get help to prepare me for the future”

Maintaining and developing community links and opportunities to engage in mainstream activities including social care, education, employment, housing, transport and leisure services.

√ √

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Competencies Learning Disability Generic Service Interventions Pathway Competency Framework

Learning Disability Transition Pathway Competency Framework

What It means for people with learning disabilities

Therapeutic interventions

Physical healthcare (including dysphagia and seizures management

Evidence-based talking therapies √

Medications management. √

Family and carer interventions

Carers’ assessments √ √ “The people who help me all the time get looked after too”

“The people that look after me all the time get looked after too”

“My family is helped when they need it”

“The people who help me get the information they need to help them make decisions/plan my future”

Maintaining relationships √

Supporting families (including siblings) √

Supporting carers with their needs √ √

Supporting carers to undertake the caring role

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The Learning Disability Transition Pathway Competency Framework identifies things that people who provide learning disability services during transition need to know and do when supporting a young person in transition. Each section identifies the skills and knowledge required to under-take the specific activity. These statements were informed by people working with young people in transition. To ensure consistency, these have been mapped to the National Occupational Standards that describe each competency. The sections applicable to each worker will depend on their job role.

Competencies Learning Disability Generic Service Interventions Pathway Competency Framework

Learning Disability Transition Pathway Competency Framework

What It means for people with learning disabilities

Accommodation and welfare interventions

Practical housing support √ √ “I choose where I want to live and get help to pay for the things I need”“I choose when I want to live on my own”

Accessing benefits √ √

Monitoring and measurement

Physical health observations (focus on complications associated with learning disabilities)

√ “My care is managed well and I am involved in all decisions”

“I feel safe and I am allowed to make mistakes just like everyone else”

“I am kept up to date”

“I know where and when I am going and I have time to say Good-bye”

“Someone asks me if things are ok”

Mental wellbeing state √

Effectiveness of family carer interventions

Effectiveness of accommodation and welfare interventions

Effectiveness of enabling and therapeutic interventions

Effectiveness of role support interventions

Effectiveness of care programme approach and risk management activities

√ √

Service-user satisfaction √ √

The ‘Health Equalities Framework’ (HEF).

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1. Team competencies at transitionThe members of a transition team have a range of knowledge, some of it specific to each profession. All should have knowledge of the following:

Team skills required by an individual

Requires a knowledge and understanding of: Requires the ability to:

• learning disability and related issues, relevant legislation, local and national policy • transition arrangements as applicable to each of the involved services e.g. the

different roles and responsibilities, eligibility and criteria assessment processes, and the requirements of the education, health and care plan

• commissioning arrangements and responsibilities• mental health• evidence based practice including Positive Behaviour Support models• services available in the locality• processes and procedures for inter-agency working• what ‘joined up’ working means in practice• key working/care coordination• person centred planning.

• communicate and negotiate with a range of people in a variety of situations• work in partnership with a range of people in different organisations to ensure best

outcome for the person at transition• challenge assumptions and resolve conflicts• organise and keep records• act as a co-ordinator, providing a consistent point of contact and timely

interventions• reflect on practice and develop own team skills• contribute to the development of your own service.

Related National Occupational Standards

Communicate significant news to individuals CHS48

Promote effective communication and relationships with people who are troubled or distressed GEN99

Promote effective communication in a healthcare environment GEN98

Reflect on and evaluate your own values, priorities, interests and effectiveness GEN12

Make use of supervision GEN36

Contribute to the development of the multidisciplinary team and its members GEN40

Develop capacity and capability to improve health and wellbeing PHS21

Contribute to the development and promotion of the organisation and its services SFJHF26

Implement and evaluate joint operational policies and care pathways PSL9

Comply with an external audit of data and information in a health context HI10.2010

Build a partnership between the team, patients and carers CM C5

Comply with an external audit of data and information in a health context HI10 2010

Build a partnership between the team, patients and carers

CM C5Contribute to effective multidisciplinary team working GEN39

Identify team members need for psychological support GEN41

Support team and virtual working LSIILARD3v2

Promote the effectiveness of teams SCDHSC3121

Participate in inter-disciplinary team working to support individuals SCDHSC3100

Help individuals address problems affecting their performance CFAM&LDC5

Build teams CFAM&LDB1

Manage conflict in teams CFAM&LDB8

Allocate work to team members CFAM&LDB2

Enable workers and agencies to work collaboratively GEN122

Work in co-operation with other organisations SFJ_CCAA1

Share information with other organisations SFJ_CCAA2

Support the efficient use of resources SfJHE8

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2. Leadership competencies at transition

Leadership skills needed in situations where in some cases the leaders may not have direct line of authority require an individual to use many skills and behaviours, including communication and negotiation skills, which encourage all involved to want to achieve the best and most appropriate outcomes for the young person concerned.

Leadership skills

Requires a knowledge and understanding of:

• the environment in which the organisation operates and an understanding of current research and developments in learning disability care and support

• transition arrangements as applicable to each of the involved services, i.e. eligibility criteria, assessment processes

• the requirements of the education, health and care plan• inter-agency working and the roles and responsibilities of the multi-disciplinary

team.• commissioning arrangements and responsibilities• relevant legislation, local and national policy • services available in the locality.

• support those who need care and support, taking care of staff • influence the quality of care across the sector• provide direction, disseminate best practice and to monitor, motivate and support

staff to meet their objectives• influence the culture of their workplace regarding desired attitudes and ways of

working, such as promoting value based, person-centred approaches to care• work collaboratively to deliver integrated services as part of a multi-agency team• resolve conflicts.

Related National Occupational Standards

SFHGEN126 Monitor, evaluate and improve inter-agency services for addressing health and wellbeing needs

SCDLMCA2 Lead and manage change within care services

SCDHSC0439 Contribute to the development of organisational policy and practice

CFAM&LCA1 Identify and evaluate opportunities for innovation and improvement

SCDCPC315 Contribute to establishing commissioning priorities and balancing demands on resources

SCDHSC0433 Develop joint working arrangements for health and social care services

SCDLMCB3 Lead and manage the provision of care services that deals effectively with transitions and significant life events

CFAM&LBA2 Provide leadership in your area of responsibility

GEN53 Support the development of strategies to meet local needs for health care services

SCDCPC315 Contribute to establishing commissioning priorities and balancing demands on resources

GEN124 Lead the development of inter-agency services for addressing health and wellbeing needs

GEN125 Lead the implementation of inter-agency services for addressing health and wellbeing needs

GEN131 Support and challenge teams and agencies on specific aspects of their practice

GEN132 Support and challenge workers on specific aspects of their practice

PROHSP6 Control health and safety risks

CFAM&LFE5 Manage continuous improvement

CFAM&LBA2 Provide leadership in your area of responsibility

CFAM&LCA3 Engage people in change

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3. Access to services, care coordination and risk management at transition

Promoting appropriate access to services: supporting individuals

Requires a knowledge and understanding of: Requires the ability to:

• how to promote the service, verbal, written (e.g. easy read), electronic, formal or informal, and what reasonable adjustment means

• why and how good written and verbal communication, including by telephone, is essential. Particularly at transition

• eligibility criteria/requirements e.g. age, disability, terms of the service at transition

• how to support the most appropriate referral, fully taking into account the views of the young person and their needs

• how to support access to own agency, other agencies, services within social care/other organisations, local people/services and community links

• the meaning of person centred planning.

• promote the service in a variety of ways e.g. verbal, written (e.g. easy read), electronic, formal or informal, offering guidance

• communicate effectively with people with communication difficulties, including written, verbally and by telephone

• assess young people for eligibility at transition

• signpost when appropriate.

• plan a transition pathway for a young person.

Related National Occupational Standards

Provide advice and information to those who enquire about health and social care services Ref: SCDHSC0419

Advise and inform others on services Ref: CHS174

Advise on access to and use of services Ref: CHS177

Support individuals to access information on services and facilities Ref: SCDHSC0026

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Promoting appropriate access to services: planning and implementing services

Requires a knowledge and understanding of: Requires the ability to:

• pathways and pathway planning particularly in relation to transition from children’s to adults’ services

• demographic information relevant to future planning

• pathways and pathway commissioning, and the specific issues related to a transition

• the Special Educational Needs and Disability (SEND) Code of Practice

• local pathways available to support a transition, and awareness of the local offer and available services

• service planning and service development including multi agency collaborative working

• commissioning arrangements and responsibilities

• resources and funding streams, and how they may be accessed and used effectively

• how the roles of a co-ordinator and a navigator can benefit the implementation of a pathway

• how policy and processes relating to care provision, care programme and planning are developed.

• plan, commission and develop services

• plan and develop pathways for a service

• use information relating to the population to inform planning

• develop policy and processes leading to care planning/provision

• identify any unmet needs/gaps in current service provision.

Related National Occupational Standards

Support the development of strategies to meet local needs for health care services Ref: GEN53

Contribute to establishing commissioning priorities and balancing demands on resources Ref: SCDCPC315

Lead the development of inter-agency services for addressing health and wellbeing needs Ref: GEN124

Lead the implementation of inter-agency services for addressing health and wellbeing needs Ref: GEN125

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Managing referrals, transfers, transitions/discharges

Requires a knowledge and understanding of: Requires the ability to:

• relevant codes of practice, appropriate legislation, law, protocols and procedures

• awareness of who should be involved in the transition workforce and their roles

• the multi-disciplinary team including:

• a key worker to coordinate and explain options

• adult social worker and children’s social worker

• appropriate health professionals with specific knowledge e.g. learning disability nurse, psychiatrist, psychologist, specialist occupational therapist, physiotherapist

• welfare benefits officer, carers support officer, housing project officer and any others as appropriate

• person centred planning

• how specific pathways for professions fit into the overall transition pathway

• the role of liaison professionals, particularly in relation to the criminal justice system

• how to support transitions e.g. from children’s to adults’ services acute-community, out of area-in area

• how to plan discharge from services

• eligibility criteria and assessment processes

• commissioning, funding costs and benefits

• local services and the process and time scales

• the Mental Health Act relating to discharge and the associated roles and responsibilities

• the importance of record keeping

• information sharing protocols.

• prepare the young person for the transition

• facilitate/contribute to education, health and care (EHC) plan

• work as part of the multi-disciplinary team and contribute to multi-disciplinary team decision making

• take part in multi-disciplinary team referral meetings

• co-ordinate care

• manage/support management of the transition from education/children’s services to adults’ services

• carry out appropriate handover

• carry out or contribute to discharge planning

• resolve conflict

• progress and support referrals into other services.

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Related National Occupational Standards

Manage provision of care services that deals effectively with transitions and significant life events Ref: SCDLMCSB3

Work with others to facilitate the transfer of individuals between agencies and services Ref: GEN123

Refer individuals to specialist sources of assistance in meeting their health care needs Ref: CHS99

Support individuals to secure services in order to achieve outcomes Ref: SCDCPC316

Assist in the transfer of individuals between agencies and services Ref: SCDHSC0386

Arrange services and support with other health care providers Ref: CHS98

Prepare a discharge plan with individuals Ref: CHS122

Inform an individual of discharge arrangements Ref: GEN16

Contribute to the discharge of an individual into the care of another service Ref: GEN17

Discharge and transfer individuals from a service or your care Ref: GEN28

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Managing care plan approach, including care planning

Requires a knowledge and understanding of: Requires the ability to:

• Education, Health and Care (EHC) Plan and the Transition Pathway

• the Care Plan Approach Framework

• all professional roles and contributions and where your own role fits into the EHC/care plan

• how to contribute to/lead on care planning

• person centred planning and what personalisation means

• how to construct and write a person centred, outcome focused care plan/support plan

• how to contribute to/manage care-coordination

• what a legal and ethical approach involves (including mental capacity assessment, best interests assessment, Special Educational Needs Code of Practice (SEND), the Transforming Care agenda), when and how these are relevant, and incorporating positive risk taking

• the timescales relevant to transition relating to different services

• appropriate funding and resources in the service area and how to access them

• disability and relevant health issues including co -morbid health related conditions, complex physical health requirements, behaviour that challenges, psychological healthy living environments

• the Health Action Plan

• the use of advocacy to support the young person and broker and/ or enable health interventions

• information sharing protocols and the importance of record keeping.

• write/contribute to an Education, Health and Care (EHC) Plan/support plan, employing a person centred and outcome focused approach

• contribute/manage care-coordination

• co-ordinate, inform, and support other professionals, care givers/staff to manage particular interventions, working collaboratively

• manage a care programme

• interpret and apply standards and legislation

• use professional judgement and make decisions

• monitor and record/report appropriately

• monitor progress and care, review outcomes and make appropriate changes

• manage expectations, know the young person, understand the family, think of the family and their needs assessing each case on an individual basis

• use accessible language and accessible resources.

Related National Occupational Standards

Obtain valid consent or authorisation Ref: CHS167

Plan activities, interventions and treatments to achieve specified health goals Ref: CHS44

Enable individuals to make informed health choices and decisions Ref: PE1

Develop care pathways for patient management Ref: CHS173

Contribute to the assessment of needs and the planning, evaluation and review of individualised programmes of care for individuals Ref: CHS233

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Positive risk management including risk to self and others, safeguarding and personal safety

Requires a knowledge and understanding of: Requires the ability to:

• the requirements and uses of risk assessment

• person centred, values-based risk assessment in the context of transition

• how and when it should take place

• the decision making process

• positive risk management

• the safeguarding issues arising in the changing contexts of transition

• safeguarding procedures

• implications and monitoring in all contexts including bed-based services, community settings, home settings and the ability to fulfil the safeguarding role, including emotional, financial, physical and sexual

• the role of culture in safeguarding situations

• the management of actual or potential aggression and the impact on health needs

• proactive and reactive strategies and environmental issues, least restrictive principle, safe restrictive physical interventions

• the role of Positive Behavioural Support.

• undertake a risk assessment, use a risk assessment toolkit relevant to the context of the service user and act accordingly

• demonstrate formulation of decision making around risk assessment

• carry out and integrate a risk assessment into the planning of transition and provision of care

• work with the multi-disciplinary/systems/families/carers to assess and manage risk, in conjunction with safeguarding

• manage and monitor the safeguarding issues arising in the changing contexts of transition

• manage actual or potential aggression in line with current legal requirements.

Related National Occupational Standards

Promote the safeguarding of children and young people Ref: SCDHSC0034

Promote the safeguarding of individuals Ref: SCDHSC0035

Recognise and respond to possible abuse of children and young people Ref: CS18

Contribute to the prevention and management of abusive, aggressive and challenging behaviour Ref: GEN134

Identify, assess and review the risk of violence to workers Ref: PMWRV2

Protect yourself and others from the risk of violence at work Ref: PMWRV3

Make sure communication is effective following an incident of violence at work Ref: CFAWRV10

Develop risk management plans to promote independence in daily living Ref: SCDHSC0450

Minimise the risks to an individual and staff during clinical interventions and violent and aggressive episodes Ref: FMH5

Assess the need for intervention and present assessments of individuals’ needs and related risks Ref: CHS230

Assess individuals’ needs and circumstances and evaluate the risk of abuse, failure to protect and harm to self and others Ref: CHS229

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4. Assessment and formulation

Undertaking assessment processes including functional analysis

Requires a knowledge and understanding of: Requires the ability to:

• the process of transition

• the process of assessment, which may be:

• standard

• generic

• specialist

• repeat

• mental/physical health conditions

• complex

• profession specific

• of daily activities

• how a single assessment may be used

• the use assessment tools

• triage

• how to analyse and process assessment findings to determine interventions necessary, make professional judgements and inform decision making

• functional analysis.

• undertake assessments which may be:

• standard

• generic

• specialist

• repeat

• mental/physical health conditions

• complex

• profession specific

• of daily activities.

• undertake triage assessments

• use assessment tools

• analyse assessment findings and determine interventions indicated

• undertake functional analysis.

Related National Occupational Standards

Assess risks associated with health conditions Ref: CHS46

Assess an individual’s health status Ref: CHS39

Assess individual preferences and needs Ref: SCDHSC0414

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Mental capacity

Requires a knowledge and understanding of: Requires the ability to:

• the underpinning knowledge required in the context of transition to inform assessment

• the process of assessment

• assessment tools how they are used and what they indicate

• the Mental Capacity Act, Mental Capacity Assessment and who should be involved

• autism.

• carry out/lead on carrying out a mental capacity assessment

• communicate and share information with teams to ensure a positive outcome for the young person

• take into account the implications of the mental capacity assessment when planning a transition

• refer onto to specialist services where required.

Related National Occupational Standards

Plan inter-disciplinary assessment of the health and well-being of individuals Ref: CHS52

Assess the need for intervention and present assessments of individuals’ needs and related risks Ref: CHS230

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5. Enabling interventions

Leadership skills

Requires a knowledge and understanding of: Requires the ability to:

• the information required to help the young person to make choices

• how agreements are reached and parameters set up for support services to meet a young person’s needs at transition

• methods of communication needed to enable the young person to make choices

• ways to adapt information and knowledge formats to make information accessible and to meet a range of communication needs

• how to actively listen

• valid consent and its implications.

• set up parameters, agreements and/or contracts for support services to meet a young person’s needs at transition and into adulthood

• communicate in a way the young person can understand, adapt formats, and make information accessible

• engage, inform, guide and support young people while allowing them to make own choices

• enable young people to make informed judgements, particularly with respect to risk management

• raise aspirations to enable young people to reach their potential

• use active listening skills

• use the principles of valid consent in practice.

Related National Occupational Standards

Procure services for individuals Ref: SCDHSC0443

Support individuals to secure services in order to achieve outcomes Ref: SCDCPC316

Provide advice and information to individuals on how to manage their own condition Ref: GEN14

Enable individuals and families to identify factors affecting, and options for, optimising their health and well-being Ref: GEN106

Provide advice and information to children and young people and those involved in their care on how to manage their own condition Ref: CS30

Support individuals to access information on services and facilities Ref: SCDHSC0026

Support individuals to represent their own wishes and needs at decision-making events Ref: SCDHSC0366

Provide information and advice to support individuals in undertaking desired occupational and non-occupational activities Ref: GEN46

Agree actions to assist individuals in undertaking desired occupational and non-occupational activities Ref: GEN47

Support individuals to manage their own health and social well-being Ref: SCDHSC3112

Support individuals to use services and facilities Ref: SCDHSC0330

Enable people with mental health needs to choose and participate in activities that are meaningful to them Ref: MH38.2013

Enable people with mental health needs to participate in activities and networks Ref: MH42.2013

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Promoting effective communication about needs

Requires a knowledge and understanding of: Requires the ability to:

• how to communicate and work with other providers, colleagues and stakeholders to achieve best outcomes for a young person at transition

• the young person’s social, educational and health needs.

• communicate and work with other providers to achieve the best outcome for a young person at transition and into adulthood.

Related National Occupational Standards

Develop and sustain productive working relationships with colleagues Ref: CFAM&LDD1

Develop and sustain productive working relationships with stakeholders Ref: CFAM&LDD2

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6. Role support interventions

Supporting person centred activities and functioning (including mitigating stigmatising factors and promoting social, spiritual and sexual health, independence, personal budgets, communication and personal care)Requires a knowledge and understanding of: Requires the ability to:

• how the physical and mental changes related to adolescence will affect the young person at transition

• relevant legislation e.g. Deprivation of Liberties, Human Rights Act

• the importance of person centred planning

• culture diversity, gender, sexuality including safe sex

• how to engage young people with a range of communication needs

• different models of support

• health action plans

• services available: independent/private sector provision, Educational/vocational activities, community activities and transport provision, step down beds, in the context of transition

• supported living, personal assistants and direct payments

• sources of funding and how to access them

• the use of technology to support the young person

• family dynamics in relation to care provision

• the influence of demographics.

• involve and engage young people, putting them at the centre

• evaluate the needs of the young person with consideration for:

• provision of a safe and supportive environment

• capable environments

• formation of plans

• identification of young person’s wishes

• promoting independence

• education/vocational requirements

• carer/family competencies

• psychological support

• physical support, equipment and adaptations

• support with skills required for daily living, such as safe travel and handling money

• social integration

• management of reasonable adjustments

• the interface with other agencies, e.g. maternity, police

• be outcome focused

• recognise that changes associated with adolescence may change the requirements of the young person

• access support services available

• identify and access sources of funding

• support the young person with respect to personal budgets and money management.

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Related National Occupational Standards

Support individuals to use services and facilities Ref: SCDHSC0330

Support individuals in undertaking their desired activities Ref: GEN15

Implement development activities to meet individuals’ goals, preferences and needs Ref: SCDHSC0351

Support individuals to retain, regain and develop skills to manage their daily living Ref: SCDHSC0344

Enable individuals to maintain the safety and security of their living environment Ref: GEN104

Support Individuals who are distressed Ref: SCDHSC0226

Support individuals in relation to personal and social interactions and environmental factors Ref: GEN110

Support individuals to manage their own health and social well-being Ref: SCDHSC3112

Support individuals to manage change in their lives Ref: SCDHSC0382

Support individuals to manage their financial affairs Ref: SCDHSC0345

Support individuals to manage direct payments Ref: SCDHSC0346

Support individuals to represent their own wishes and needs at decision-making events Ref: SCDHSC0366

Advocate with and on behalf of individuals Ref: SCDHSC0410

Advocate with and on behalf of children and young people Ref: SCDHSC0046

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Maintaining and developing community links and opportunities to engage in mainstream activities including social care, education, employment, housing, transport and leisure servicesRequires a knowledge and understanding of: Requires the ability to:

• the ‘local offer’ and the range of services available in the local community and the opportunities that are available to the young person

• how to provide young people with advice and support to help with making choices, for example with respect to housing.

• at transition, evaluate the needs of the young person with consideration for preparation for adulthood and promoting their independence with respect to:

• formation of plans

• education/vocational requirements

• carer/family competencies

• psychological support

• physical support, equipment and adaptations

• social needs and support with skills such as travel training

• social integration

• management of reasonable adjustments

• the interface with other agencies, e.g. maternity, police

• provide advice and support to young people to enable them to make choices.

Related National Occupational Standards

Support individuals to access employment Ref: SCDHSC0347

Enable people with mental health needs to choose and participate in activities that are meaningful to them Ref: MH38.2013

Enable people with mental health needs to participate in activities and networks Ref: MH42.2013

Support individuals to access housing and accommodation services Ref: SCDHSC0349

Support individuals to move into new living environments Ref: SCDHSC0383

Support children and young people to achieve their educational potential Ref: SCDHSC0039

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7. Family and carer interventions

Carer’s assessments

Requires a knowledge and understanding of: Requires the ability to:

• the potential change in needs of carers during transition

• carer’s assessments, their purpose and content.

• liaise with social workers and health workers working together to improve the quality of the carer’s assessment

• carry out a carer’s assessment/ informal carer’s assessment.

Related National Occupational Standards

Assess the needs of carers and families Ref: SCDHSC0427

Contribute to working in partnership with carers Ref: SCDHSC0227

Supporting carer’s with their needs

Requires a knowledge and understanding of: Requires the ability to:

• the needs of carers

• interventions that can support carers during transition

• how to provide interventions that will meet the carer’s needs

• positive behaviour strategies

• how to advise and support carers

• the value of respite care, and how to access it.

• involve carers in planning the care of young people

• provide interventions that will help to meet the carer’s needs

• train, advise and support staff and carers to utilise positive behaviour strategies

• provide information in a suitable/accessible format.

Related National Occupational Standards

Enable carers to access and assess support networks and respite services Ref: CHD HN3

Work in partnership with carers to support individuals Ref: SCDHSC0387

Assess the needs of carers and families Ref: SCDHSC0427

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8. Accommodation and welfare interventions

Accessing benefits

Requires a knowledge and understanding of: Requires the ability to:

• where to get specialist help

• systems/methods of physically supporting young people to express their preferences

• the systems and mechanisms involved in joint working across professional boundaries and services

• benefits and allowances.

• work across professional boundaries, as part of the multi-disciplinary team on behalf of the young person

• integrate accommodation and welfare interventions with other interventions

• transfer knowledge to external provider

• signpost young people to a means of accessing benefits and allowances.

Related National Occupational Standards

Support individuals to manage their financial affairs Ref: SCDHSC0345

Support individuals to manage their financial affairs Ref: SCDHSC0345

Practical housing support

Requires a knowledge and understanding of: Requires the ability to:

• the different models of support housing/accommodation options for young people with a learning disability and their availability

• assistive technology and how to access it

• systems/methods of physically supporting young people to express their preferences

• the systems and mechanisms involved in joint working across professional boundaries and services.

• support young people to express their choices about where they want to live

• assess environment and determine whether it meets the young person’s needs

• work across professional boundaries, as part of the multi-disciplinary team on behalf of the young person -

• give input to housing/accommodation assessments for young people with a learning disability

• integrate accommodation and welfare interventions with other interventions

• transfer knowledge to external provider

• help determine and support appropriate long term housing.

Related National Occupational Standards

Develop and sustain collaborative relationships with other organisations Ref: CFAM&LDD4

Promote housing opportunities for individuals Ref: SCDHSC0422

Support individuals to access housing and accommodation services Ref: SCDHSC0349

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9. Monitoring and measurement, research and evaluation

Effectiveness of care programme approach and risk management strategy

Requires a knowledge and understanding of: Requires the ability to:

• why the level of support may reduce over time but that there is often a lifetime of need, which will vary but will always need monitoring and measurement

• indicators for the monitoring and measurement of care e.g. number of incidents, young people’s stories, young people’s feedback, young and achievement of outcomes

• how to carry out electronic risk management recording

• where to find research and development evidence and how to use it to underpin ways of working to benefit the young person

• other services and the requirement for a good interface between mental health/learning disability services/other services - particularly respite care, acute services, primary care, social care, day care, probation service.

• set measurable goals in a plan and evaluate them

• monitor risks in order to evaluate the strategy

• use theory and legislation to underpin decision making and practice

• use research evidence and methods of service improvement to improve quality

• act as agents for change to improve the quality of service for young people using the service.

Related National Occupational Standards

Evaluate the effectiveness of health, social or other care services Ref: SCDHSC0442

Monitor, evaluate and improve inter-agency services for addressing health and wellbeing needs Ref: GEN126

Evaluate the delivery of care plans to meet the needs of individuals Ref: CHS53

Support and challenge teams and agencies on specific aspects of their practice Ref: GEN131

Support and challenge workers on specific aspects of their practice Ref: GEN132

Control health and safety risks Ref: PROHSP6

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Service user satisfaction

Requires a knowledge and understanding of: Requires the ability to:

• how the effectiveness of an service may be assessed qualitatively and quantitatively

• measuring outcomes

• how data and information may be presented

• indicators that influence the service user’s satisfaction e.g. waiting times, disability discrimination

• relevant standards, quality standards and Guidelines, e.g. National Institute for Health and Care Excellence (NICE).

• undertake assessments of the satisfaction of the young person and carers using the service

• review the young person’s care

• identify whether outcomes have been achieved and how they relate to the young person’s expectations

• assess quality of life - interpret actions and feedback that indicate the young person’s satisfaction

• use information and feedback to improve services for the benefit of young people using the service.

Related National Occupational Standards

Collect and validate data and information in a health context Ref: HI7.2010

Identify the concerns, priorities and values of people and significant others in relation to their mental health and mental health needs Ref: MH62.2013

Monitor, evaluate and improve processes for delivering health and wellbeing services to a population Ref: GEN117

Improve the quality of health and healthcare interventions and services through audit and evaluation Ref: PHS08

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Appendix 1 - Generic Service Interventions Pathway

Promoting appropriate access to services

Therapeutic interventions

Assessment, formulation and treatment planning

Role support interventions

Enabling health interventions

Family and carer interventions

Monitoring and measurements

Accommodation and welfare interventions

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The Learning Disability Workforce Competency Framework Generic Service Interventions Pathway (Figure 1) was commissioned by Health Education England to support development of the learning disability workforce. A number of statements were developed by an expert reference group to explain the activities that are required to deliver the intervention. These were further examined to identify the skills and knowledge required to undertake the specified activities. To ensure consistency, these were mapped to the National Occupational Standards that describe each competence. The framework supports workforce competency mapping, skills gap analysis and effective commissioning of services and education.

Scope and supporting informationThe framework covers clinical learning disability workforce roles in delivery of care for people with complex needs and should be viewed in the context of system-wide efforts to ensure that services are delivered by caring, compassionate, knowledgeable, skilled and supported staff.The framework does not include organisational skills and so excludes:• leadership and management skills

• six core dimensions of the NHS Knowledge and Skills Framework (KSF)

• administrative and clerical functions

• information and technology skills.

While all points on the Generic Service Interventions Pathway remain relevant to the individual during transition, some areas have been identified as of particular significance and are included in the new Transition Competency Framework, with additional detail.

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Appendix 2 - Transition workshopTo inform the scoping and development of a competency framework for learning disability focusing on the transition between children’s and adult services

A workshop was held in Birmingham, on Monday 16th May 2016, to inform the scoping and development of a competency framework for learning disability focusing on the transition between children’s and adult services. 39 delegates from a range of services across the West Midlands attended. Included in the aims of the workshop were:

• to scope a regional transition pathway

• to inform the development of a multi-agency competency framework for transition

• to identify what we can do to improve transition where required.

Areas discussed

• Who are the people in the transition workforce?

• The transition pathway

• What does the Transition Pathway look like?

• What happens when and where?

• Transition

• What, if anything, needs to change?

• What are the current challenges in transition?

• How could these be overcome?

• What competencies does the transition workforce require?

• Knowledge and skills needed by the whole transition workforce and specialist roles.

1. Who is the transition workforce?This is a multi-agency workforce. Information collated was used to inform the diagram, which can be found in the Background section of this document. The list of jobs included: training providers, teachers, social care workers, benefits agents, connexions staff, politicians (if there are problems), commissioners, and regulatory bodies such as OFSTED and the CQC. Health workers including GPs, community nurses, psychology, psychiatry, speech and language therapists. Day service staff, hospice staff, short breaks service staff, as well as the parents, family and the young person themselves.

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2. What does the transition pathway look like? It was clear that there was no standard pathway for transition. There were varied approaches across the services, some more developed than others, different ages at which different services start to engage with the young person, and changes in eligibility as the young person moves through the system.

3. Solutions

• The need for advance planning was identified, but with the proviso that potential changes in circumstances required a flexible approach, to avoid sudden or late changes

• Joint commissioning

• Closer more joined up working/Shared values/Pooled thinking

• Transition team/workforce know what they are doing and work together

• Clear pathway between health and social care

• Early training for everyone

• Person centred

• Earlier involvement

•Family interdependence

• It was felt by a number of delegates that there was a strong case for a dedicated Transition worker, with navigation and co-ordination skills

• An improved approach to planning

• Single point of access

• Communication and transparency with commitment from the top to make it work

• Early information sharing

• A focus on those who do not have a high level of need, these might fall between the gaps

• Funding through CHC

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4. Staff competences were identified as:

General: Specialist:

• risk management that is person centred

• knowledge of legislation

• better training including negotiation and mediation

• shared vision commitment and empathy

• advocacy, consistency and knowing your part in sign-posting

• safeguarding workforce – knowing when and who to refer to

• good record keeping, patience and resilience.

• making reasonable adjustments for individuals

• specialist legal knowledge

• single assessor

• legislation

• key-workers challenging assumptions and offering choices

• knowledge of accessible funding.

• co-ordination of care

• having systems in place

• communication

• commissioning

• accessible language

• appropriate knowledge of health professionals

• understanding young people’s needs.

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Appendix 3 - Young people’s consultationA workshop was held with a small group of young people with learning disabilities at present undergoing transition, from Regent College, Stoke on Trent. They were presented with the graphic below, which was used to illustrate the outcomes of the workshop held previously (Appendix 2).

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The views from the young people undergoing transition reinforced the concerns expressed by the transition workshop delegates, as illustrated in the graphic produced at the workshop here.

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Appendix 4 - Learning Disabilities Core Skills Education and Training FrameworkThe Learning Disabilities Core Skills Education and Training Framework, was commissioned and funded by the Department of Health and developed in collaboration by Skills for Health, Skills for Care and Health Education England. The framework describes core skills and knowledge that is common and transferable across different types of service provision. Specialist skills and knowledge are outside the scope of the framework. Following the transition workshop, it was clear that of particular relevance to the Learning Disabilities Transition Pathway Competency Framework are:

Subject 2: Communication in learning disability care and support

Subject 4: Person-centred care and support for people (children, young people and adults) with learning disabilities

Subject 9: Preparing young people with learning disabilities for adulthood

Subject 19: Leadership and management in learning disability care and support settings.

Subject 2: Communication in learning disability care and support

IntroductionPeople (children, young people and adults) with learning disabilities face particular challenges around communication. A learning disability affects the way a person understands information and how they communicate and most people (children, young people and adults) with learning disabilities have some difficulties with speech, language, communication and/or sensory impairment. These can be hidden or overlooked. It is therefore important to know what good communication support ‘looks like’, how organisations can contribute to minimising communication difficulties and what reasonable adjustments may be needed. In order to communicate effectively it is essential to understand and value an individual’s speech, language, sensory and communication needs and preferences

Target audienceTier 2 staff that will have some regular contact with people (children, young people

and adults) with a learning disability Tier 3 staff providing care and support for people (children, young people and adults)

with a learning disability

Key learning outcomesTier 2 The learner will: a) know that communication is critical for supporting the autonomy, wellbeing and

quality of life of people (children, young people and adults) with learning disabilities

b) understand that each person (child, young person and adult) with a learning disability will have a unique way of communicating

c) understand that all behaviour is a form of communication and meaningful to the person (child, young person and adult) with a learning disability

d) be able to interact successfully with people (children, young people and adults) with

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learning disabilities

e) be able to convey information to people (children, young people and adults) with learning disabilities, their families and carers in a way they can understand

f) be able to listen to people (children, young people and adults) with learning disabilities and understand what they are communicating

g) understand the importance of confidentiality in interactions with people (children, young people and adults) with learning disabilities, including recognising the nuances and limitations of confidentiality. 22

h) know why individualised communication plans should be developed, implemented and reviewed with people (children, young people and adults) with learning disabilities

i) know the importance of ensuring that people (children, young people and adults) with learning disabilities have any required sensory support (e.g. spectacles, hearing aids) to enable successful communication

j) understand the importance of effective communication with families and carers and the expertise that families and carers may be able to offer to support effective communication with the person (child, young person and adult) with a learning disability

k) be able to use a range of communication techniques according to the different abilities and preferences of people (children, young people and adults) with learning disabilities

l) understand the importance of non-verbal communication e.g. body language, signing, visual images and the appropriate use of touch

m) know the key functions of communication as they relate to behaviours that challenge

n) understand the Disability Equality Duty in terms of the legal requirement for public agencies to make anticipatory reasonable adjustments, including in methods of communicating with people.

Tier 3 Tier 2 learning outcomes plus the following The learner will: a) understand why communication is critical for supporting autonomy, wellbeing and

quality of life and the role of supervision in supporting this

b) understand communication needs and factors affecting them

c) understand how to support the use of assistive technology to enhance communication

d) be able to improve communication systems and practices that support positive outcomes for people (children, young people and adults) with learning disabilities

e) be able to actively support, develop and change communication systems for each person (child, young person and adult) with a learning disability

f) be able to support staff in the understanding of more complex communication needs

g) be able to support assessment and intervention components that address alternate functional communication

h) be able to utilise a range of augmentative and alternative communication methods and services that meet the communication needs of people (children, young people and adults) with learning disabilities

i) understand the connection between behaviours that challenge and the communication needs of people (children, young people and adults)

j) understand the importance of teaching and supporting alternative behaviour matched to the communicative function of behaviours that challenge

k) understand how service systems and processes can sometimes put barriers in the way of effective communication with people (children, young people and adults)

with learning disabilities and families and carers.

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Relevant guidance and/or legislationSources of further guidance are shown in Appendix 1. Examples of national guidance or legislation with specific relevance to communication in learning disability care and support are shown below.

Guidance

• Generic Service Interventions Pathway: A competency framework to support development of the learning disability workforce, Health Education England (2015)

• Positive Behavioural Support: A Competence Framework - Positive Behavioural Support (PBS) Academy (May 2015)

• Five good communication standards: Reasonable adjustments to communication that individuals with learning disability and/or autism should expect in specialist hospital and residential settings - Royal College of Speech and Language Therapists (2013)

Legislation

• Care Act (2014)

• Children and Families Act 2014

• Equality Act 2010

• Disability Discrimination Act 1995

• Human Rights Act 1998

• Mental Capacity Act 2005

Indicative mapping to relevant national standards or frameworks

National Occupational Standards

• GEN97 Communicate effectively in a healthcare environment

• HSC 3029 Support individuals with specific communication needs

• SCDCCLD0201 Support effective communication

• SCDHSC0031 Promote effective communication

• SCDLADSS1 Communicate, engage and build positive relationships with children and young people and their families

• SFHCHS152 Assess an individual’s communication skills and abilities

• CHS 156 Develop activities and materials to enable individuals to achieve specified communication goals

• CHS 157 Provide support to individuals to develop their communication skills

• CHS154.2014 Develop, prepare and maintain resources for use by individuals who use Augmentative and Alternative Communication (AAC) systems

• CHS158 Enable individuals from diverse linguistic and cultural backgrounds to access Speech and Language Therapy services

• GEN85 Support individuals with communication and interaction difficulties

• CHS155.2014 Assist and support individuals to use Augmentative and Alternative Communication (AAC) systems

Generic Service Interventions Pathway • Pathway point 4: therapeutic interventions page 24

UK Core Skills Training Framework• Clinical/Care Subject 4: Communication page 12

• Care Certificate Standards

• Standard 6: Communication

Regulated Qualifications Framework components• Learning disability pathways in level 2 and level 3 diplomas

• Level 2 Award in Supporting Individuals with Learning Disabilities

• Level 2 Certificate in Supporting Individuals with Learning Disabilities

• Level 3 Award in Supporting Individuals with Learning Disabilities

• Level 3 Certificate Supporting Individuals with Learning Disabilities

• Level 4 Diploma in Adult Care (England)

• Level 5 Diplomas in Leadership In Health And Social Care And Children And Young People’s Services.

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Subject 4: Person-centred care and support for people (children, young people and adults) with learning disabilities

IntroductionPerson-centred thinking and planning is at the heart of much recent policy relating to the provision of care and support for people (children, young people and adults) with learning disabilities. It refers to a family of approaches aimed at enabling people (children, young people and adults) who use care and support to plan their own futures and to get the support they need. While the terminology varies between different user groups, the fundamental values of the concept are the same – embracing the principles of independence, choice, inclusion, equality and empowerment as the foundations of care and support. Person-centred thinking and planning in learning disability care and support is about understanding and responding to the person (children’s, young person and adult) with a learning disability as an individual. It involves considering the whole person, taking into account each individual’s life history, unique abilities, interests, preferences and needs. It is about building relationships with people (children, young people and adults) with a learning disability and their family and carers, putting them in the driving seat of decision making.

Target audienceTier 2 staff that will have some regular contact with people (children, young people

and adults) with a learning disabilityTier 3 staff working with/caring for people (children, young people and adults) with

a learning disability

Key learning outcomesTier 2The learner will:a) be aware of the values underpinning person-centred thinking and planning with

people (children, young people and adults) with learning disabilities

b) know the principles and practice of person centred thinking and planning in care

and support for people (children, young people and adults) with learning disabilities

c) know how to support people (children, young people and adults) with learning disabilities using person-centred values

d) know how to involve people (children, young people and adults) with learning disabilities who don’t use verbal language to communicate their needs

e) understand the significance of a person (children’s, young person and adult) with a learning disability’s background, culture and experiences when providing care and support

f) understand how person-centred thinking and planning can provide insights into care and support approaches and solutions to meeting the needs of people (children, young people and adults) with learning disabilities

g) understand the important role of family and carers in person-centred thinking and planning with people (children, young people and adults) with learning disabilities

h) understand the importance of clear processes to communicate the care and support needs of people (children, young people and adults) with learning disabilities

i) understand own role in person-centred thinking and planning with people (children, young people and adults) with learning disabilities

j) be able to contribute to the gathering of information about a person (children’s, young person and adult) with a learning disability’s strengths, needs, preferences, hopes, dreams and desires for their person centred plan

k) be able to schedule the implementation of and measure progress towards goals important to the person (children’s, young person and adult) with a learning disability

l) be able to monitor that implementation balances across areas of life, type of outcome and preferences

m) be able to participate in person-centred planning meetings

n) understand the principles and practices of co-production.

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Tier 3Tier 2 learning outcomes plus the followingThe learner will:a) understand the theory and principles that underpin person centred thinking and

planning in care and support for people (children, young people and adults) with learning disabilities

b) understand the value of person-centred care and support in therapeutic relationships and communication

c) understand how to implement a person-centred approach for people (children, young people and adults) with learning disabilities

d) be able to lead person-centred practice for people (children, young people and adults) with learning disabilities

e) understand the importance of establishing consent when providing care or support for people (children, young people and adults) with learning disabilities

f) understand how to ensure a person (children’s, young person and adult) with a learning disability can exercise their right to make choices

g) understand the role of positive risk taking in enabling a person-centred approach

h) understand duty of care in relation to supporting positive risk-taking

i) be able to work in partnership with a person (children’s, young person and adult) with a learning disability and others to facilitate person-centred assessment

j) be able to carry out person-centred assessment that promotes social, emotional, cultural, spiritual, intellectual and physical wellbeing

k) be able to implement personalised systems for goal-based person-centred outcome planning, implementing plans, and monitoring their impact

l) be able to incorporate person-centred thinking and planning in the management and development of services

m) be able to incorporate co-production in the management and development of services.

Relevant guidance and/or legislationSources of further guidance are shown in Appendix 1. Examples of national guidance or legislation with specific relevance to person-centred care and support for people (children, young people and adults) with learning disabilities are shown below.

GuidanceGeneric Service Interventions Pathway: A competency framework to support development of the learning disability workforce, Health Education England (2015) Positive Behavioural Support: A Competence Framework - Positive Behavioural Support (PBS) Academy (May 2015)

Legislation• Care Act (2014)

• Children and Families Act 2014

• Human Rights Act 1998

• Equality Act 2010

• Disability Discrimination Act 1995

• Mental Capacity Act 2005

Indicative mapping to relevant national standards or frameworks

National Occupational Standards• SCDHSC0234 Uphold the rights of individuals

• SCDHSC0332 Promote individuals’ positive self-esteem and sense of identity

• SCDHSC0350 Support the spiritual wellbeing of individuals

• SCDHSC0351 Implement development activities to meet individuals’ goals, preferences and needs

Generic Service Interventions Pathway • Pathway point 1: Promoting appropriate access to service page 8

• Pathway point 2: Assessment, formulation and treatment planning page 14

• Pathway point 5: Role support interventions page 32

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UK Core Skills Training Framework• Clinical/Care Subject 3: Person-centred care page 10

Care Certificate Standards• Standard 5: Work in a person-centred way

Regulated Qualifications Framework components• Level 2 Award in Supporting Individuals with Learning Disabilities (RQF)

• Level 2 Certificate in Supporting Individuals with Learning Disabilities (RQF)

• Level 3 Diploma in Health And Social Care (Adults) England (Learning Disability)

• Level 4 Diploma in Diploma in Adult Care England

• Level 5 Diplomas in Leadership In Health And Social Care And Children And Young People’s Services

Subject 9: Preparing young people with learning disabilities for adulthood

IntroductionThe Children and Families Act 2014 introduces a new SEND system. At the heart of these changes is a commitment to ensuring that children, young people and their families are at the centre of decision-making so that they achieve better outcomes.From year nine the SEND reforms require those supporting young people to focus on ordinary life outcomes such as paid employment; independent living (choice and control over your life and support, and good housing options); community participation (friends, relationships and community inclusion); and health and wellbeing. The new system requires a joined up approach including co-production, holistic planning and multi-agency working.The implications for workforce development are significant, as the SEND reforms represent a change not just in process but also in thinking about outcomes, coproduction, and what it takes to support young people to move into adulthood with ordinary lives.

Target audience

Tier 2 staff that will have some regular contact with young people with a learning disability

Tier 3 staff providing care and support for young people with a learning disability

Key learning outcomesTier 2The learner will:a) be aware of the steps and stages of moving from childhood into adulthood for

young people with learning disabilities

b) know how having a learning disability may affect the process of moving from childhood into adulthood

c) know how to support a young person with a learning disability through a successful transition into adulthood

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d) be aware of how the welfare benefits system and other supports systems can help or act as a barrier throughout a young person with a learning disability’s transition into adulthood

e) know the options for supporting a young person with a learning disability to make the transition into adulthood

Tier 3Tier 2 learning outcomes plus the followingThe learner will:a) be able to support a young person with a learning disability through transition into

adulthood

b) understand the importance of supporting a young person with a learning disability and their family and carers to reflect on the transition into adulthood

c) be able to support a young person with a learning disability and their family and carers to reflect on the transition into adulthood

d) understand the difference in ethos and practice between statements, LDAs and EHC plans

e) know national best practice and the evidence base in relation to helping young people with learning disabilities prepare for adulthood

f) know what is required for an EHC plan to be compliant

g) understand how specific person-centred practices contribute to the information required in EHC plans

h) understand the process of the Preparing for Adulthood review

i) be able to facilitate the Preparing for Adulthood review, and how to ensure that everyone is fully prepared

j) understand the difference between good and poor outcomes

k) be able to co-produce summaries that young people with learning disabilities and their families and others can understand, under the relevant headings.

Relevant guidance and/or legislationSources of further guidance are shown in Appendix 1. Examples of national guidance or legislation with specific relevance to preparing young people with learning disabilities for adulthood are shown below.

Guidance• Special educational needs and disability code of practice: 0 to 25 years (DFE, 2013)

• The Preparing for Adulthood Review: A Good Practice Toolkit (NDTi, January 2015)

• Generic Service Interventions Pathway: A competency framework to support development of the learning disability workforce, Health Education England (2015)

Legislation• Children and Families Act 2014

• Care Act 2014

• Disability Discrimination Act 1995

• Apprenticeship, Skills, Children and Learning Act 2006

• Education Act 2011

Indicative mapping to relevant national standards or frameworksNational Occupational Standards• SCDLMCSB3 Manage provision of care services that deal effectively with transitions

and significant life events

• GEN123 Work with others to facilitate the transfer of individuals between agencies and services

Generic Service Interventions Pathway (HEE, 2015)• Pathway point 1: Promoting appropriate access to service

Regulated Qualifications Framework components• Level 2 Award in Supporting Individuals with Learning Disabilities (RQF)

• Level 2 Certificate in Supporting Individuals with Learning Disabilities (RQF)

• Level 3 Certificate in Supporting Individuals with Learning Disabilities (RQF)

• Level 3 Award in Supporting Individuals with Learning Disabilities (RQF)

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Subject 19: Leadership and management in learning disability care and support settings

IntroductionThe delivery of high quality learning disability care and support requires skilled, qualified and confident leaders and managers.People working in a leadership or management role in learning disability care and support are not only responsible for supporting those who need care and support, but for taking care of their staff and influencing the quality of care across the sector.Leaders and senior managers have a responsibility to provide direction, disseminate best practice and to motivate and support staff in meeting their objectives. This requires an understanding of the environment in which the organisation operates and an understanding of current research and developments in learning disability care and support. Leaders can also influence the culture of their workplace regarding desired attitudes and ways of working (such as promoting value-based, person-centred approaches to care). As well as supporting staff in their own organisation, leaders will be required to work collaboratively to deliver integrated services as part of a multi-agency team.

Target audienceTier 2 staff that will have some regular contact with people (children, young people and adults) with a learning disabilityTier 3 staff providing care and support for people (children, young people and adults) with a learning disability

Key learning outcomesTier 2The learner will:a) understand the importance of co-production with people with learning disabilities

and their families and carers

b) understand the changing nature of learning disability care and support and the impact of current developments on own role

c) know why management and leadership styles need to be adapted to manage different situations in learning disability care and support

d) understand the features of effective team performance within learning disability care and support

e) be able to support a positive culture within the team for learning disability care and support

f) be able to promote a shared vision within the team for learning disability setting

g) be able to develop a plan with team members to meet agreed objectives for a learning disability setting

h) be able to support individual team members to work towards agreed objectives in learning disability care and support

i) be able to describe strategies and tools that could be adopted to reduce stress levels, to build resilience and to maintain the wellbeing of staff within the team

j) be able to manage conflict situations during professional supervision in learning disability care and support

k) be able to evaluate own practice when conducting professional supervision in learning disability care and support

l) be able to lead inclusive provision that gives individuals’ choice and control over the outcomes they want to achieve

m) know the appropriate type and level of resources required to deliver safe and effective services in learning disability care and support

n) know the induction requirements for staff in learning disability care and support.

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Tier 3Tier 2 learning outcomes plus the followingThe learner will:a) be able to work with people with learning disabilities and families and carers to co-

produce services, resources, and support models

b) be aware of the key drivers and policies which influence national learning disability strategy and service development

c) be able to anticipate and prepare for the future by scanning for ideas, best practice and emerging trends that will have an impact on outcomes for people (children, young people and adults) with learning disabilities

d) be aware of evidence-based research, innovations and developments in learning disability care and support

e) understand the current legislative framework and organisational health, safety and risk management policies, procedures and practices that are relevant to learning disability care and support

f) be able to implement and monitor compliance with health, safety and risk management requirements in learning disability care and support

g) be able to lead the implementation of policies, procedures and practices to manage risk to individuals and others in learning disability care and support

h) be able to promote a culture where needs and risks are balanced with health and safety practice in learning disability care and support

i) be able to improve health, safety and risk management policies, procedures and practices in learning disability care and support

j) know the importance of challenging poor and unethical practice in learning disability care and support

k) understand the importance of demonstrating leadership in delivering compassionate person-centred care

l) understand the importance of learning and development and support in meeting the needs of people (children, young people and adults) with learning disabilities

m) understand the importance of collecting quality assurance information including feedback from people (children, young people and adults) with learning disabilities and their families and carers

n) be able to obtain and act on the feedback and experiences of people (children, young people and adults) with learning disabilities andtheir families and carers

o) be able to develop creative solutions to transform care and support for people (children, young people and adults) with learning disabilities

p) understand the importance of collaborative working in the provision of care and support for people (children, young people and adults) with learning disabilities and their families and carers

q) be aware of the roles and responsibilities of different agencies involved in learning disability care and support

r) understand the importance of systems leadership in supporting people (children, young people and adults) with learning disabilities

s) be able to work across services and organisations to meet the needs of the growing number of people (children, young people and adults) with learning disabilities and complex medical conditions and those who rely on care and support from different agencies.

Relevant guidance and/or legislationSources of further guidance are shown in Appendix 1. Examples of national guidance or legislation with specific relevance to leadership and management in learning disability care and support settings are shown below.

Guidance• The Leadership Qualities Framework For Adult Social Care (NSA)

• Positive Behavioural Support A Competence Framework - Positive Behavioural Support (PBS) Coalition UK (May 2015)

• NHS Leadership Academy

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Indicative mapping to relevant national standards or frameworks

National Occupational Standards• SFHGEN126 Monitor, evaluate and improve inter-agency services for addressing

health and wellbeing needs

• SCDLMCA2 Lead and manage change within care services

• SCDHSC0439 Contribute to the development of organisational policy and practice

• CFAM&LCA1 Identify and evaluate opportunities for innovation and improvement

• SCDCPC315 Contribute to establishing commissioning priorities and balancing demands on resources

• SCDHSC0433 Develop joint working arrangements for health and social care services

• SCDLMCB3 Lead and manage the provision of care services that deals effectively with transitions and significant life events

• CFAM&LBA2 Provide leadership in your area of responsibility

• GEN53 Support the development of strategies to meet local needs for health care services

• SCDCPC315 Contribute to establishing commissioning priorities and balancing demands on resources

• GEN124 Lead the development of inter-agency services for addressing health and wellbeing needs

• GEN125 Lead the implementation of inter-agency services for addressing health and wellbeing needs

• GEN131 Support and challenge teams and agencies on specific aspects of their practice

• GEN132 Support and challenge workers on specific aspects of their practice

• PROHSP6 Control health and safety risks

• CFAM&LFE5 Manage continuous improvement

• CFAM&LBA2 Provide leadership in your area of responsibility

• CFAM&LCA3 Engage people in change

Generic Service Interventions Pathway (HEE, 2015)Pathway point 1: Promoting appropriate access to serviceManager Induction Standards (Skills for Care)• Standard 5: Team leadership and management

Regulated Qualifications Framework components• Level 4 Diploma in Adult Care (England)

• Level 5 Diplomas in Leadership In Health And Social Care And Children And Young People’s Service

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Appendix 5 - Career framework

Commissioners may require a narrative that describes the level at which the activity is required to be carried out by the post-holder, and also information relating to the values and behaviours which should be inherent in the activity. Skills for Health career framework levels are summarised here. Table 2 is included with the relevant employability skills.

Career framework level summaryA role at level 8 of the career framework requires highly specialised knowledge, some of which is at the forefront of knowledge in a field of work, and is used as the basis for original thinking and/or research.

This is a leadership role with considerable responsibility, and the ability to research and analyse complex processes. It may entail responsibility for service improvement or development, considerable management responsibilities and accountability for service delivery or a leading education or commissioning role.

A role at level 7 of the career framework requires a critical awareness of knowledge issues in the field and at the interface between different fields. It is innovative, and has a responsibility for developing and changing practice and/or services in a complex and unpredictable environment.

A role at level 6 requires a critical understanding of detailed theoretical and practical knowledge, is specialist and /or has management and leadership responsibilities. It requires demonstration of initiative and is creative in finding solutions to problems. It has some responsibility for team performance and service development and they consistently undertake self development.

A role at level 5 requires a comprehensive, specialised, factual and theoretical knowledge within a field of work and an awareness of the boundaries of that knowledge.

It requires use knowledge to solve problems creatively, make judgements which require analysis and interpretation, and actively contribute to service and self development. It may have responsibility for supervision of staff or training.

A role at level 4 requires factual and theoretical knowledge in broad contexts within a field of work. The work is guided by standard operating procedures, protocols or systems of work, but the worker is required to make judgements, plan activities, contribute to service development and demonstrate self development. There may be responsibility for supervision of some staff.

A role at level 3 requires knowledge of facts, principles, processes and general concepts in a field of work.

It may include a wider range of duties than a level 2 role, and will have more responsibility, with guidance and supervision available when needed. It is required to contribute to service development, and is responsible for self development.

A role at level 2 requires basic factual knowledge of a field of work.

It may be required to carry out clinical, technical, scientific or administrative duties according to established protocols or procedures, or systems of work.

Table 1

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Table 2

Career framework level Summary of employability skills: positive attitudes, values and behaviours

Level 8 Everything in lower levels plus:

• Listen to, understand and communicate complex information from a range of sources, adopting effective questioning techniques to elicit and appreciate a range of views

• Respond constructively and confidently to queries and complaints, negotiating with others in a way that suits the situation, demonstrating a high level of theoretical and practical knowledge

• Be responsible for the efficient and cost effective management of a budget for one or more services

• Assess the root cause of problems in complex and unpredictable environments

• Seek and evaluate different points of view and use highly specialised theoretical and practical knowledge to inform solutions and make decisions

• Make strategic decisions and be responsible for own actions and the actions of your team, reflecting on own practice and encouraging others to reflect on theirs

• Be responsible for the direct delivery of a service, assessing and managing risk

Level 7 Everything in lower levels plus:

• Respond constructively and confidently to queries and complaints, negotiating with others in a way that suits the situation

• Evaluate a range of texts and write effectively for a range of contexts and situations, maintaining honesty, integrity and transparency

• Select, compare and discuss mathematical information from a range of sources and use appropriate mathematical method and tools to solve identified problems and assist with clinical trials, audits or research projects as required

• Manage a work area budget cost effectively and efficiently

• Ensuring the team’s goals are clear and achievable

• Learn from own mistakes, accepting and giving constructive feedback

• Seek and evaluate different points of view to inform solutions, maintaining honesty, integrity and transparency

• Show interest in your work, developing, with the team, a clear purpose and work objectives

• Seek and value the contributions of others, managing and resolving conflict when appropriate

• Lead, support, value and motivate other members of the team, sharing information as appropriate to achieve high performance

• Take responsibility for own actions and the actions of your team, reflecting on own practice and encouraging others to reflect on theirs

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Career framework level Summary of employability skills: positive attitudes, values and behaviours

Level 6 Everything at lower levels plus:

• Listen to, understand and communicate complex information, using effective questioning techniques to elicit a range of views

• Respond constructively and confidently to queries and complaints, ensuring contributions meet the needs of the audience and persuading and influencing others in a way that builds team confidence and promotes the confidence of service users

• Read and understand a range of texts, writing effectively for a range of contexts and situations, maintaining honesty, integrity and transparency

• Select, compare and discuss information from lists, tables, diagrams and charts and use appropriate mathematical methods and tools to solve identified problems and assist with clinical trials, audits or research projects as required

• Work with others towards achieving shared goals, learning from mistakes and being open to the opinions of others including service users, receiving and giving constructive feedback

• Demonstrate honesty, integrity, care and compassion when dealing with others, taking the lead on promoting personal and group health and safety procedures

• Assess the root cause of problems in complex and unpredictable environments

• Be creative and innovative in implementing solutions, maintaining honesty, integrity and transparency

• Show interest in your work, developing, with the team, a clear purpose and work objectives

• Seek and value the contributions of others, managing and resolving conflict when appropriate

• Lead, support and motivate other members of the team

• View change as an opportunity and cope with uncertainty, assessing and managing risk

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Career framework level Summary of employability skills: positive attitudes, values and behaviours

Level 5 Everything at lower levels plus:

• Respond constructively to queries and complaints, taking full part in formal and informal discussions, ensuring contributions meet the needs of the audience and asking questions to clarify understanding and persuading and influencing others in a way that builds team confidence

• Read and understand a range of texts, writing effectively for a range of contexts and situations

• Select, compare and discuss information from lists, tables, diagrams and charts and use appropriate mathematical methods and tools to solve identified problems and assist with clinical trials, audits or research projects as required

• Use IT to meet identified needs and plan and evaluate the work of the team effectively, maintaining confidentiality

• Demonstrate honesty, integrity, care and compassion when dealing with others, taking the lead on promoting personal and group health and safety procedures

• Assess the root cause of problems, and be creative and innovative in implementing solutions, maintaining honesty, integrity and transparency

• Show interest in your work, seeking and valuing the contributions of others and managing conflict when appropriate

• Understand your rights and responsibilities in the workplace including promoting equality of opportunity and valuing diversity, maintaining the confidentiality of service users and raising concerns relating to service provision with more senior staff

• View change as an opportunity and cope with uncertainty, assessing and minimising risk

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Career framework level Summary of employability skills: positive attitudes, values and behaviours

Level 4 Everything at the lower levels plus:

• Communicate clearly, effectively and confidently with people in the workplace, following detailed and/or multi-step instructions

• Respond constructively to queries and complaints, taking full part in formal and informal discussions, ensuring contributions meet the needs of the audience and asking questions to clarify understanding

• Analyse a range of texts, produce effective emails, short reports, presenting information in a manner suitable or the audience

• Select and compare information from lists, tables, diagrams and charts and use appropriate mathematical methods to solve identified problems and assist with clinical trials, audits or research projects as required

• Use IT to meet identified needs and plan work effectively, maintaining confidentiality

• Work with others towards achieving shared goals, learning from mistakes and being open to the opinions of others including service users, receiving and giving constructive feedback

• Demonstrate honesty, integrity, care and compassion when dealing with others

• Assess the root cause of problems, and deal with them and with people with honesty and integrity, showing interest in your work and seeking and valuing the contributions of others

• Suggest alternative ways to get the job done without compromising compassionate care for service users

• Pro-actively raise concerns about the provision of services to service users with supervisor and managers

• Understand your rights and responsibilities in the workplace including promoting equality of opportunity and valuing diversity and maintaining the confidentiality of service users

• Make best use of resources including time, to achieve agreed goals for service delivery, taking responsibility for own actions and self-development and demonstrating effective team leadership

• Be open and respond constructively to change, coping with uncertainty and assessing and minimising risk

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Career framework level Summary of employability skills: positive attitudes, values and behaviours

Level 3 Everything at lower levels plus the following:

• Respond constructively to queries and complaints, taking full part in formal and informal discussions, ensuring contributions meet the needs of the audience

• Analyse a range of texts, produce effective emails, short reports, presenting information in a manner suitable for the audience

• Select and compare information from lists, tables, diagrams and charts and use appropriate mathematical methods to solve identified problems

• Receive and give constructive feedback

• Deal with a range of people with honesty and integrity, showing interest in your work and seeking and valuing the contributions of others

• Be open and respond constructively to change, coping with uncertainty and taking the lead in supporting others in the team as appropriate

Career framework level Summary of employability skills: positive attitudes, values and behaviours

Level 2 • Communicate effectively with people in the workplace

• Listen and respond in formal and informal discussions, asking questions to clarify understanding

• Understand a range of texts, write simply and clearly and complete straightforward forms and work records

• Complete simple calculations and understand and use simple charts, tables and graphs, extracting relevant information as required

• Use IT as directed, maintaining confidentiality

• Work with others towards achieving shared goals, learning from mistakes and being open to the opinions of others including service users

• Demonstrate honesty, integrity, care and compassion when dealing with others

• Deal with a range of problems with honesty and integrity, showing interest in your work and seeking and valuing the contributions of others

• Suggest alternative ways to get the job done without compromising compassionate care for service users

• Pro-actively raise concerns about the provision of services to service users with supervisor and managers

• Understand your rights and responsibilities in the workplace including promoting equality of opportunity and valuing diversity and maintaining the confidentiality of service users

• Make best use of resources including time, to achieve agreed goals for service delivery, taking responsibility for own actions and self-development